This is an exact quote from a patient of mine in the office, and an all-too-common situation.

Men have heart attacks ten years sooner, on average. We die ten years sooner too, largely from sudden cardiac death. In fact, my patient who lost her husband had her first stent a few years back— but with quitting smoking and taking her medicines she has on average another 20 years to live!

But was her husband’s passing truly “unexpected”? More importantly, was it preventable? If so, how?

After consoling her, the preventive cardiologist in my couldn’t help but pry a bit. So I inquired about her husband.

She explained to me that Jack also quit smoking about four years ago, when she did. “You’ve seen him at my appointments, he’s got a bit of a belly.” He tried to walk regularly, she explained, but only when the weather permitted. He opted out of any preventive medications since his cholesterol “wasn’t that bad”, and he’d never had any heart trouble. He had no symptoms before “just dropping dead”. “He just clenched his chest and hit the floor, like it was a movie. He was at his friend’s place.”

Jack’s passing was certainly not expected, but it wasn’t all that surprising either.
His annual risk of heart attack and sudden death was around 2%. The ACC/AHA online ASCVD calculator quickly tells you that, especially if you factor in that he was a smoker for most of his life.

It’s no secret that I promote Cardiac Calcium Scoring (CCS)— in an effort to avoid this exact situation.

I can’t be sure a CCS done ten years earlier would have motivated Jack to quit smoking sooner. Or start a statin. Or to be more faithful to his exercise regimen.

I can’t be sure that he would have avoided plaque rupture, and that sudden cardiac event last month, even if he adopted a healthy lifestyle and took preventive medications.

But wouldn’t it have been more honest to have at least shown Jack his plaque, and warned him of the risks he faces? Shouldn’t we have identified him as high risk before this irrevocable event?

Maybe not. Maybe we have to accept these untoward events, and my patient was just destined to live alone for a few decades. Maybe we simply can’t save them all. Maybe it was Jack’s fault alone —he knew cigarettes are bad for you, and he knew he should lose weight.

For the doctors reading, who don’t routinely incorporate CCS into their prevention strategy with patients —I urge you to send your next 10 intermediate risk patients like Jack. I promise it will alter your prevention plan and engage your higher risk patients more often than not.

For men and women getting up in age (men >50, women >60) — I urge you to consider whether it’s time to start screening for heart attack and sudden death, with CCS. For their wives, children and loved ones…maybe it’s time to initiate that discussion. [Get a copy of “Get More from Your Score” today and learn more!]

For everyone, consider why we screen for cancer with pap smears, mammograms, PSA and colonoscopies — but just cross our fingers when it comes to the #1 killer in America, cardiovascular disease?

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